Conduct Disordernn

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Conduct Disorder

SYMPTOMS

The essential feature of Conduct Disorder is a repetitive and persistent pattern of behavior bya child or teenager in which the basic rights of others or major age-appropriate societal norms

or rules are violated. These behaviors fall into four main groupings: aggressive conduct that

causes or threatens physical harm to other people or animals, nonaggressive conduct that

causes property loss or damage, deceitfulness or theft, and serious violations of rules time and

time again.

Specific Symptoms of Conduct Disorder

Conduct Disorder is characterized by a repetitive and persistent pattern of behavior in which

the basic rights of others or major age-appropriate societal norms or rules are violated, as

manifested by the presence of three (or more) of the following criteria in the past 12 months,with at least one criterion present in the past 6_months:

Aggression to people and animals

often bullies, threatens, or intimidates others often initiates physical fights has used a weapon that can cause serious physical harm to others (e.g., a bat, brick,

broken bottle, knife, gun)

has been physically cruel to people has been physically cruel to animals has stolen while confronting a victim (e.g., mugging, purse snatching, extortion,

armed robbery)

has forced someone into sexual activityDestruction of property

has deliberately engaged in fire setting with the intention of causing serious damage has deliberately destroyed others' property (other than by fire setting)

Deceitfulness or theft

has broken into someone else's house, building, or car often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but

without breaking and entering; forgery)

Serious violations of rules

often stays out at night despite parental prohibitions, beginning before age 13 years has run away from home overnight at least twice while living in parental or parental

surrogate home (or once without returning for a lengthy period)

is often truant from school, beginning before age 13 years


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The disturbance in behavior causes clinically significant impairment in social, academic, or

occupational functioning.

If the individual is age 18 years or older, criteria are not met for Antisocial Personality

Disorder.

Two subtypes of Conduct Disorder are provided based on the age at onset of the disorder

(i.e., Childhood-Onset Type and Adolescent-Onset Type). The subtypes differ in regard to the

characteristic nature of the presenting conduct problems, developmental course and

prognosis, and gender ratio. Both subtypes can occur in a mild, moderate, or severe form. In

assessing the age at onset, information should preferably be obtained from the youth and

from caregiver(s). Because many of the behaviors may be concealed, caregivers may

underreport symptoms and overestimate the age at onset.

Childhood-Onset Type. This subtype is defined by the onset of at least one criterion

characteristic of Conduct Disorder prior to age 10 years.

Individuals with Childhood-Onset Type are usually male, frequently display physical

aggression toward others, have disturbed peer relationships, may have had

Oppositional Defiant Disorder during early childhood, and usually have symptoms

that meet full criteria for Conduct Disorder prior to puberty. These individuals are

more likely to have persistent Conduct Disorder and to develop adult Antisocial

Personality Disorder than are those with Adolescent-Onset Type.

Adolescent-Onset Type. This subtype is defined by the absence of any criteria

characteristic of Conduct Disorder prior to age 10 years. Compared with those with

the Childhood-Onset Type, these individuals are less likely to display aggressive

behaviors and tend to have more normative peer relationships (although they often

display conduct problems in the company of others). These individuals are less likely

to have persistent Conduct Disorder or to develop adult Antisocial Personality

Disorder. The ratio of males to females with Conduct Disorder is lower for the

Adolescent-Onset Type than for the Childhood-Onset Type

Conduct Disorder Subtypes

Subtypes of Conduct Disorder

There are two subtypes of conduct disorder

Childhood-onset type is defined by the onset of one criterion characteristic of conduct

disorder before age 10. Children with childhood-onset conduct disorder are usually male, and

frequently display physical aggression; they usually have disturbed peer relationships, and

may have had oppositional defiant disorder during early childhood. These children usually

meet the full criteria for conduct disorder before puberty, they are more likely to have

persistent conduct disorder, and are more likely to develop adult antisocial personality

disorder than those with the adolescent-onset type (American Psychiatric Association, 1994).

Adolescent-onset type is defined by the absence of conduct disorder prior to age 10.

Compared to individuals with the childhood-onset type, they are less likely to displayaggressive behaviors. These individuals tend to have more normal peer relationships, and are


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less likely to have persistent conduct disorders or to develop adult antisocial personality

disorder. The ratio of males to females is also lower than for the childhood-onset type

(American Psychiatric Association, 1994).

Severity of symptoms

Conduct disorder is classified as "mild" if there are few, if any, conduct problems in excess of

those required for diagnosis and if these cause only minor harm to others (e.g., lying, truancy

and breaking parental rules). A classification of "moderate" is applied when the number of

conduct problems and effect on others are intermediate between "mild" and "severe". The

"severe" classification is justified when many conduct problems exist which are in excess of

those required for diagnosis, or the conduct problems cause considerable harm to others or

property (e.g., rape, assault, mugging, breaking and entering) (American Psychiatric

Association, 1994).

Co-morbidities and associated disorders

Children with conduct disorder are part of a population within which there are higher

incidences of a number of disorders than in a normal population. The literature abounds with

studies indicating the comorbid relationships between Attention Deficit Hyperactivity

Disorder, Conduct Disorder, Oppositional Defiant Disorder, Learning Difficulties, Mood

Disorders, Depressive symptoms, Anxiety Disorders, Communication Disorders, and

Tourettes Disorder. (American Psychiatric Association, 1994; Biederman, Newcorn, &

Sprich, 1991). A high level of co-morbidity (almost 95%) was found among 236 ADHD

children (aged 6-16 yrs) with conduct disorder, ODD and other related categories (Bird,

Gould, & Staghezza Jaramillo, 1994). In an 8 year follow-up study, Barklay and colleagues

(1990) found that 80% of the children with ADHD were still hyperactive as adolescents andthat 60% of them had developed Oppositional Defiant or Conduct Disorder.

Prevalence of Conduct Disorder.

According to research cited in Phelps & McClintock (1994), 6% of children in the United

States may have conduct disorder. The incidence of the disorder is thought to vary

demographically, with some areas being worse than others. For example, in a New York

sample, 12% had moderate level conduct disorder and 4% had severe conduct disorder. Since

prevalence estimates are based primarily upon referral rates, and since many children and

adolescents are never referred for mental health services, the actual incidences may well be

higher (Phelps & McClintock, 1994)

Other Useful Links regarding Conduct Disorder

Symptoms of Conduct Disordero This page is dedicated to the varioussymptoms of conduct disorder

Course of Conduct Disordero The onset of conduct disorder may occur as early as age 5 or 6, but more

usually occurs in late childhood or early adolescence, learn more about the

course of conduct disorder

Causes of Conduct Disordero Read more about the variouscauses of conduct disorder, including, biological,

family, genetic, neurological, parent related, and school factors.
http://cannontherapy.com/conduct_disorder/overview.htmlhttp://cannontherapy.com/conduct_disorder/overview.htmlhttp://cannontherapy.com/conduct_disorder/overview.htmlhttp://cannontherapy.com/conduct_disorder/course.htmlhttp://cannontherapy.com/conduct_disorder/course.htmlhttp://cannontherapy.com/conduct_disorder/causes.htmlhttp://cannontherapy.com/conduct_disorder/causes.htmlhttp://cannontherapy.com/conduct_disorder/causes.htmlhttp://cannontherapy.com/conduct_disorder/causes.htmlhttp://cannontherapy.com/conduct_disorder/course.htmlhttp://cannontherapy.com/conduct_disorder/overview.html


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Treatment of Conduct Disordero Learn more about the varioustreatment options for conduct disorderincluding

family intervention, education, and child training

Conduct Disorder (CD)

What is conduct disorder (CD)?

Conduct disorder is a behavior disorder, sometimes diagnosed in

childhood, that is characterized by antisocial behaviors which violate

the rights of others and age-appropriate social standards and rules.

Antisocial behaviors may include irresponsibility, delinquent behaviors

(such as truancy or running away), violating the rights of others (such

as theft) and physical aggression toward others (such as assault or rape). These behaviors sometimes

occur together, however, one or several may occur without the other(s).

What causes conduct disorder? The conditions that contribute to the development of conduct

disorder are considered to be multifactorial, with many factors (multifactorial) contributing to the

cause. Neuropsychological testing has shown that children and adolescents with conduct disorders

seem to have an impairment in the frontal lobe of the brain that interferes with their ability to plan,

avoid harm and learn from negative experiences. Childhood temperament is considered to have agenetic basis. Children or adolescents who are considered to have a difficult temperament are more

likely to develop behavior problems. Children or adolescents from disadvantaged, dysfunctional and

disorganized home environments are more likely to develop conduct disorders. Social problems and

peer group rejection have been found to contribute to delinquency. Low socioeconomic status has

been associated with conduct disorders. Children and adolescents exhibiting delinquent and

aggressive behaviors have distinctive cognitive and psychological profiles when compared to

children with other mental health problems and control groups. All of the possible contributing

factors influence how children and adolescents interact with other people.

Who is affected by conduct disorder? Rates of CD in children vary widely, with reported ranges

of 6 to 16 percent for males and 2 to 9 percent for females. The disorder is more common in boys

than in girls by a 4:1 ratio and is believed to be more prevalent in urban rather than in rural settings.

Children and adolescents with conduct disorders often have other psychiatric problems as well that

may be a contributing factor to the development of the conduct disorder. The prevalence of conduct

disorders has increased over recent decades. Aggressive behavior is the reason for one-third to one-

half of the referrals made to child and adolescent mental health services.

What are the symptoms of conduct disorder? Most symptoms seen in children with conduct

disorder also occur at times in children without this disorder. However, in children with conduct

disorder, these symptoms occur more frequently and interfere with learning, school adjustment,

See also ...

Handouts/Teaching sheets
http://cannontherapy.com/conduct_disorder/treatment.htmlhttp://cannontherapy.com/conduct_disorder/treatment.htmlhttp://cannontherapy.com/conduct_disorder/treatment.htmlhttp://www.chw.org/display/PPF/DocID/32977/Nav/1/router.asphttp://www.chw.org/display/PPF/DocID/32977/Nav/1/router.asphttp://cannontherapy.com/conduct_disorder/treatment.html


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and, sometimes, with the child's relationships with others.

The following are the most common symptoms of conduct disorder. However, each child may

experience symptoms differently. The four main groups of behaviors include the following:

Aggressive conduct.Aggressive conduct causes or threatens physical harm to others and may include the

following:

o Intimidating behavior.o Bullying.o Physical fights.o Cruelty to others or animals.o Use of a weapon(s).o Forcing someone into sexual activity, rape, molestation.

Destructive conduct.Destructive conduct may include the following:

o Vandalism; intentional destruction to property.o Arson.

Deceitfulness.Deceitful behavior may include the following:

o Lying.o Theft.o Shoplifting.o Delinquency.

Violation of rules.Violation of ordinary rules of conduct or age-appropriate norms which may include the

following:

o Truancy (failure to attend school).o Running away.o Pranks.o Mischief.o Very early sexual activity.

The symptoms of conduct disorder may resemble other medical conditions or behavioral problems.

Always consult your child's physician for a diagnosis.

How is conduct disorder diagnosed? A child psychiatrist or a qualified mental health

professional usually diagnoses conduct disorders in children and adolescents. A detailed history of

the child's behavior from parents and teachers, observations of the child's behavior, and,

sometimes, psychological testing contribute to the diagnosis. Parents who note symptoms of

conduct disorder in their child or teen can help by seeking an evaluation and treatment early. Early

treatment can often prevent future problems.

Further, conduct disorder often coexists with other mental health disorders, including mood


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disorders, anxiety disorders, post-traumatic stress disorder, substance abuse, attention-

deficit/hyperactivity disorder and learning disorders, increasing the need for early diagnosis and

treatment. Consult your child's physician for more information.

Treatment for conduct disorder: Specific treatment for children with conduct disorders will be

determined by your child's physician based on:

Your child's age, overall health and medical history. Extent of your child's symptoms. Your child's tolerance for specific medications or therapies. Expectations for the course of the condition. Your opinion or preference.

Treatment may include:

Cognitive-behavioral approaches - The goal of cognitive-behavioral therapy is to improveproblem solving skills, communication skills, impulse control and anger management skills.

Family therapy - Family therapy is often focused on making changes within the familysystem, such as improving communication skills and family interactions.

Peer group therapy - Peer group therapy is often focused on developing social skills andinterpersonal skills.

Medication - While not considered effective in treating conduct disorder, medication maybe used if other symptoms or disorders are present and responsive to medication.

Prevention of conduct disorder in childhood: As with oppositional defiant disorder

(ODD), some experts believe that a developmental sequence of experiences occurs in the

development of conduct disorder. This sequence may start with ineffective parenting

practices, followed by academic failure and poor peer interactions. These experiences then

often lead to depressed mood and involvement in a deviant peer group. Other experts,

however, believe that many factors, including child abuse, genetic susceptibility, history of

academic failure, brain damage or a traumatic experience influence the expression of

conduct disorder. Early detection and intervention into negative family and social

experiences may be helpful in disrupting the development of the sequence of experiences

that lead to more disruptive and aggressive behaviors.

Epidemiology

Prevalence & Incidence

Prevalence estimates for conduct disorder range from 1-10%.[1]

However, among incarcerated

youth or youth in juvenile detention facilities, rates of conduct disorder are between 23% and

87%.[28]
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Gender Differences

The majority of research on conduct disorder suggests that there are a significantly greater

number of males than females with the diagnosis, with some reports demonstrating a three-to-

fourfold difference in prevalence.[29]

However, this difference may be somewhat biased by

the diagnostic criteria which focus on more overt behaviors, such as aggression and fighting,which are more often exhibited by males. Females are more likely to be characterized by

covert behaviors, such as stealing or running away. Moreover, conduct disorder in females is

linked to several negative outcomes, such as antisocial personality disorder and early

pregnancy,[30]

suggesting that sex differences in disruptive behaviors need to be more fully

understood.

Females are more responsive to peer pressure[31]

including feelings of guilt[32]

than males.

Therefore, with the introduction of empathy training, the female is able to accept the guilt

factor of making another child hurt quicker than the male. This ability to learn empathy helps

keep the numbers of CD cases in females lower.

Racial/Ethnic Differences

Research on racial or cultural differences on the prevalence or presentation of conduct

disorder is limited. However, it appears that African-American youth are more often

diagnosed with conduct disorder,[33]

while Asian youth are about one-third as likely[34]

to

develop conduct disorder when compared to Caucasian youth.

Risk and protective factors

It is important to note that the development of conduct disorder is not immutable orpredetermined. There is a number of interactive risk and protective factors that can influence

and change outcomes, and in most cases conduct disorder develops due to an interaction and

gradual accumulation of risk factors.[35]

In addition to the risk factors identified under

etiology, several other variables place youth at increased risk for developing the disorder,

including child physical abuse[35]

and prenatal alcohol abuse and maternalsmoking during

pregnancy.[36]

Protective factors have also been identified, and most notably include high IQ,

being female, positive social orientations, good coping skills, and supportive family and

community relationships.[37]

ComorbidityChildren with conduct disorder have a high risk of developing other adjustment problems.

Specifically, risk factors associated with conduct disorder and the effects of conduct disorder

symptomatolology on a childs psychosocial context have been linked to overlap with other

psychological disorders.[38]

In this way, there seems to be reciprocal effects ofcomorbidity

with certain disorders, leading to increased overall risk for these youth.

Attention deficit hyperactivity disorder

ADHDis the condition most commonly associated with conduct disorders, with

approximately 25-30% of boys and 50-55% of girls with conduct disorder having a comorbid

ADHD diagnosis.[39]

While it is unlikely that ADHD alone is a risk factor for developing
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conduct disorder, children who exhibit hyperactivity and impulsivity along with aggression is

associated with the early onset of conduct problems.[1]

Moreover, children with comorbid

conduct disorder and ADHD show more severe aggression.[39]

Substance use disorders

Conduct disorder is also highly associated with both substance use and abuse. Children with

conduct disorder have an earlier onset ofsubstance use, as compared to their peers, and also

tend to use multiple substances.[40]

However, substance use disorders themselves can directly

or indirectly cause conduct disorder like traits in about half of adolescents who have a

substance use disorder.[5]

As mentioned above, it seems that there is a transactional

relationship between substance use and conduct problems, such that aggressive behaviors

increase substance use, which leads to increased aggressive behavior.[41]

Learning disabilities

While language impairments are most common,[38]approximately 20-25% of youth with

conduct disorder have some type oflearning disability.[42]

Although the relationship between

the disorders is complex, it seems as if learning disabilities result from a combination of

ADHD, a history of academic difficulty and failure, and long-standing socialization

difficulties with family and peers.[43]

However, confounding variables, such as language

deficits, SES disadvantage, or neurodevelopmental delay also need to be considered in this

relationship, as they could help explain some of the association between conduct disorder and

learning problems.[1]

Lack of Empathy

Empathy is being able to recognize feelings that other people are experiencing. Therefore,

lack of empathy is not being able to recognize feelings of others. The child diagnosed with

CD often presents with a lack of empathy. Because the child with CD is unable to place

themselves in the other persons shoes, they are unable to understand their consequences.

One of the factors of conduct disorder is a lower level of fear. Research performed[44]

on the

impact of toddlers who are exposed to fear and distress show negative emotionality (fear)

predict toddlers empathy-related responding to distress. The findings support that if a

caregiver is able to respond to infant cues, the toddler has a better ability to respond to fear

and distress. If a child does not learn how to handle fear or distress the child will be more

likely to lash out at other children. If the caregiver is able to provide therapeutic interventionteaching children at risk better empathy skills, the child will have a lower incident level of

conduct disorder.
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Conduct Disordernn